Certain classes of medications have, as a consequence of their intended action, the proclivity to cause physiologic dependence. In this context, the risk of addictive behaviors and all of those consequences becomes very high, as has been well described in the medical literature, and is a commonly known fact to regulatory and law enforcement, and in large part, to the general population. The consequences have also been well described, in terms of harms to the individual, family/social, and community/public health, and much has been said about the economic costs to health systems, law enforcement, and lost productivity, as well as the professional and even legal liability of clinicians, pharmacists, and pharmaceutical manufacturers. Yet, in spite of these harms, costs, and liabilities, the consensus of the medical profession is that these medications are essential tools in the task of diminishing physical and mental suffering.
The problem has been difficult to approach, and advances have been made in education of clinicians and pharmacists, electronic pharmacy and medical records, electronic prescribing, and professional and governmental monitoring. However, there have been few attempts to manage the problem at the patient/user level.
The medical profession has determined that the risk of addiction and diversion of these medications is so great that means have been developed to protect clinical professionals by making access to these medications difficult. That is, clinical professionals cannot trust their own intellectual understanding about addiction and professional codes of conduct to prevent them from the temptations of misuse. However, in clinical practice, the patient is entrusted to a large quantity of the medications and instructed to use sparingly, “as ordered.” The likelihood of success against impulse overlapping symptoms is poor. The necessity to provide a barrier to the impulsive use of the medications, while not a solution to abuse, is already the standard of care in the professional environment and needs to be in ambulatory medicine as well.
Medications, which are listed by the Drug Enforcement Agency (DEA) as Schedule II medications which have dependency and addiction potentials, hereinafter referred to as controlled medications, pose an even greater risk to people who suffer from dependency and addiction problems. People who require the controlled medications to diminish physical and mental pain and that suffer from dependency and addiction problems are at a huge risk for misuse of the controlled medications.